A Predictive Risk Scoring System for Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy.
A Predictive Risk Scoring System for Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy.
复制标题
胰十二指肠切除术后临床相关胰瘘的预测风险评分系统
DOI：
10.12659/msm.911499
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发表时间：
2018-08-16
期刊：
影响因子：
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通讯作者：
Jian Z
中科院分区：
文献类型：
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作者：
Xia W;Zhou Y;Lin Y;Yu M;Yin Z;Lu X;Hou B;Jian Z
背景胰瘘是胰腺切除术后的一个难题。本研究旨在建立一个评分系统来预测PD后临床相关的术后胰瘘（CR-POPF）。材料/方法回顾性分析了2009年至2017年期间接受PD的361例连续患者的临床记录。患者分为研究组（225例患者）和验证组（136例患者）。CR-POPF的定义和分类基于2016 ISGPS定义和分类系统。进行单变量和多变量逻辑回归分析，因此，我们开发了一个评分系统的基础上的回归系数的多变量逻辑回归模型。使用受试者工作特征（ROC）曲线确定预测值。结果采用以下4个因素建立了CR-POPF的预测评分系统，最高评分为6分：胰腺质地软1分（OR 2.09，95%CI 1.10-3.98，P=0.025），主胰管直径≤2.5 mm得1.5分（OR 2.72，95%CI 1.23-5.99，P=0.013），扩大淋巴结切除术0.5分（OR 1.57，95%CI 1.13-2.18，P=0.007），术后第1天血清白蛋白25-30 g/L为0.5分术后第1天血清白蛋白≤25 g/L为3分（OR 5.12，95%CI 1.82-14.41，P=0.002）。ROC曲线显示，该评分系统对验证组中的CR-POPF具有高度预测性（AUC=0.806，95%CI：0.735-0.878）。结论6分风险评分法可用于CR-POPF围手术期风险管理。
Background Postoperative pancreatic fistula remains a challenge after pancreaticoduodenectomy (PD). This study aimed to establish a scoring system to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. Material/Methods The clinical records of 361 consecutive patients who underwent PD between 2009 and 2017 were reviewed retrospectively. Patients were divided into a study group (225 patients) and a validation group (136 patients). CR-POPF was defined and classified based on the 2016 ISGPS definition and classification system. Univariate and multivariate logistic regression analyses were performed and we thus developed a scoring system based on the regression coefficient of the multivariate logistic regression model. The predictive value was determined using the receiver operating characteristic (ROC) curve. Results A predictive scoring system with a maximum of 6 points for CR-POPF was established using the following 4 factors: 1 point for soft pancreatic texture (OR 2.09, 95%CI 1.10–3.98, P=0.025), 1.5 points for main pancreatic duct diameter ≤2.5 mm (OR 2.72, 95%CI 1.23–5.99, P=0.013), 0.5 points for extended lymphadenectomy (OR 1.57, 95%CI 1.13–2.18, P=0.007), 0.5 points for a 25–30 g/L postoperative day 1 serum albumin (OR 1.43, 95%CI 1.02–2.00, P=0.037), and 3 points for postoperative day 1 serum albumin ≤25 g/L (OR 5.12, 95%CI 1.82–14.41, P=0.002). The ROC curve showed that this scoring system was highly predictive for CR-POPF in the validation group (AUC=0.806, 95%CI: 0.735–0.878). Conclusions This 6-point risk scoring system will be useful for perioperative risk management of CR-POPF.